A heel fracture, also known as a calcaneal fracture, occurs when the heel bone (calcaneus) breaks. This type of fracture often results from high-energy trauma, such as a fall from a height or a car accident. Calcaneal fractures can be serious and may involve other structures in the foot, leading to long-term complications if not treated properly.

Common Symptoms

• Severe Pain: Intense pain in the heel, especially when bearing weight.
• Swelling: Swelling around the heel and ankle.
• Bruising: Bruising and discoloration over the heel.
• Deformity: Visible deformity of the heel.
• Inability to Walk: Difficulty or inability to put weight on the affected foot.

Cause & Anatomy

• High-Energy Trauma: Falls from a height, car accidents, or sports injuries.
• Osteoporosis: Weakened bones due to decreased bone density, increasing the risk of fractures.
• Overuse: Repeated stress on the heel bone, often seen in athletes and military personnel.

Anatomy of the Heel

• Calcaneus: The largest bone in the foot, forming the foundation of the rear part of the foot and the heel.
• Talus: The bone that sits above the calcaneus and forms the lower part of the ankle joint.
• Subtalar Joint: The joint between the talus and calcaneus, allowing for side-to-side movement of the foot.

Diagnosis

• Assessment of symptoms, the mechanism of injury, and medical history.
• Physical examination to check for pain, swelling, deformity, and range of motion.
• X-rays: Initial imaging to assess the fracture.
• CT Scan: Detailed imaging to evaluate the extent of the fracture and involvement of surrounding structures.

Prevention

• Footwear: Wearing appropriate shoes with good support and cushioning, especially during high-risk activities.
• Safety Measures: Using safety equipment and following safety guidelines to prevent falls and high-impact injuries.
• Bone Health: Maintaining good bone health through a balanced diet rich in calcium and vitamin D, along with regular weight-bearing exercises.

Non-Surgical Treatment

Rest and Immobilization:

• Avoiding weight-bearing activities.
• Using crutches, a cast, or a boot to immobilize the foot and allow the bone to heal.

Ice and Elevation:

• Applying ice packs to reduce swelling.
• Keeping the foot elevated to minimize swelling.

Medications:

• Over-the-counter pain relievers like acetaminophen or NSAIDs to manage pain and inflammation.

Physical Therapy:

• Once healing begins, exercises to restore strength, flexibility, and range of motion.

Surgical Treatments

Open Reduction and Internal Fixation (ORIF):

• Surgical procedure to realign the fractured bone fragments and secure them with screws, plates, or pins.
• Indicated for displaced fractures or those involving the subtalar joint.

External Fixation:

• External devices used to stabilize the bone from the outside, sometimes used in severe fractures or when there is significant swelling.

Rehabilitation

Gradual Return to Weight-Bearing:

• Gradual progression from non-weight-bearing to partial and then full weight-bearing as healing progresses.

Physical Therapy:

• Exercises to improve strength, flexibility, and range of motion.
• Gait training to restore normal walking patterns.

Long-Term Care:

• Ongoing management to prevent complications such as stiffness, arthritis, and chronic pain.

Potential Complications

• Chronic Pain: Persistent pain if the fracture does not heal properly.
• Arthritis: Increased risk of developing arthritis in the subtalar joint.
• Stiffness: Reduced range of motion in the foot and ankle.
• Infection: Risk of infection following surgery.
• Nonunion or Malunion: Failure of the bone to heal properly or heal in the wrong position.

FAQ’s

How long does it take to recover from a heel fracture?
Recovery time varies depending on the severity of the fracture and the treatment method. It can take several months to a year for full recovery.

Can I walk with a heel fracture?
Walking is usually not recommended immediately after a heel fracture. Non-weight-bearing activities are advised until the bone begins to heal.

Do all heel fractures require surgery?
Not all heel fractures require surgery. Non-displaced fractures or those without joint involvement can often be treated non-surgically.

What are the long-term effects of a heel fracture?
Long-term effects can include chronic pain, stiffness, arthritis, and difficulty with weight-bearing activities if the fracture does not heal properly.

Can I prevent heel fractures?
While not all heel fractures can be prevented, wearing appropriate footwear, following safety measures, and maintaining good bone health can reduce the risk.